If you tuned into NBC’s This Is Us last Tuesday for the season 3 premiere, you’re one of the 10.4 million people who were exposed to a firsthand look at weight stigma, stigma around PCOS, and common misconceptions about one of the most common endocrine disorders in women - all within the first five minutes of the episode.

Quick recap: This is Us follows three adult triplets and their families as they navigate life. One triplet, Kate, lives in a larger body and was diagnosed with PCOS on this week’s episode.

I shared some thoughts on my Instagram stories (archived under “PCOS” if you missed it), but thought that a topic this deep and important deserved a few more words than I could share in 10-second clips.

PCOS and weight have a complex relationship

Right off the bat, the doctor says, “You have PCOS, which is likely linked to your weight” - which is maybe one of the biggest oversimplifications you can make about a medical condition. Here’s some things to note:

PCOS is an endocrine disorder, not merely cysts on ovaries. It affects every cell of a person’s body and is typically accompanied by metabolic changes.

A common feature of PCOS is insulin resistance (read more here), meaning that the body has a hard time utilizing glucose from food for energy. This can lead to fatigue and low energy (since glucose isn’t entering cells as expected) and increased hunger and cravings. Insulin is also a growth hormone, meaning weight gain can be a symptom of insulin resistance. I’m not sharing this (or anything, ever) to create shame around weight - but to objectively provide information about the relationship between PCOS, insulin, and metabolism.

You did not cause your PCOS

Gaining weight didn’t cause your PCOS, and losing weight won’t make it disappear. PCOS is a highly genetically-linked condition and there are so many factors that play into its development. Placing blame on patients for their medical status is a reflection on the provider, not the patient’s actions. You did not cause your PCOS.

Diets are not the treatment for PCOS

We know that diets fail in up to 97% of dieters, but this can be especially true for women with PCOS. Because of underlying insulin resistance and other metabolic changes seen in PCOS, (temporary, because all diets are) weight loss is not only less likely, but more damaging and can slow the metabolism more. Weight cycling is also inflammatory (as is PCOS itself), which plays into this relationship as well.

Looking for some non-diet ways to support your PCOS? Check out this blog post.

PCOS doesn’t mean you can’t have biological children

PCOS is a leading cause of female infertility but also one of the most treatable causes of female infertility. There’s several ways (trigger warning; stigmatizing language) to conceive biological children, many of which can be tried before escalating to IVF (this was the option presented first on This Is Us).

That being said, the reluctance of the physician on This Is Us to treat a patient in a larger body is a raw and real form of weight stigma. Many women, PCOS or no, struggle to get medical care they need and deserve due to the internalized bias of providers. If this is something you’ve experienced, please know I see you and I am so sorry. Julie Duffy Dillon has a great post on weight stigma here (including a resource to take to your doctor).

Disordered eating doesn’t just happen to those in smaller bodies

Lastly, I want to address a huge concern I’ve had through two seasons of This Is Us - the misconception that disordered eating is only disordered if the person in question is in a smaller body.

Disordered eating affects all people of all sizes. I’ve best heard it put: “It is unethical to prescribe for those in larger bodies what we would diagnose as an eating disorder in smaller bodies.”

The dieting shown on This Is Us is disordered eating. Measuring portions, obsessively counting calories (or at all), treating exercise as a way to “earn” food, forgoing social events due to the food served - all disordered, but only treated as such in a character in a smaller body on the show rather than those in larger bodies. Perpetuating the stereotype that disordered eating is only disordered for thin people is weight stigma in action.

Curious about your relationship with food? The National Eating Disorders Association has a screening tool to help. The NEDA hotline can be reached at 1-800-931-2237.